MANAGEMENT OF THE COMPLETELY STIFF PEDIATRIC KNEE

The purpose of this study was to ascertain whether aggressive surgical treatment of ankylosed knees, followed by immediate continuous passiv e motion (CPM), can restore acceptable function in children. A retrosp ective analysis was performed on five children operated on for severel y contracted knees. In all cases, extensive intraarticular pathology w as present, and lysis of adhesions, tendon lengthenings, and capsular releases were performed in each case. Cruciate ligament release, drill ing of subchondral bone, and patellectomy or meniscectomy or both also were performed in certain cases. Surgery was followed by immediate CP M for 6 weeks. Knee motion improved significantly from a preoperative mean of 7 degrees (range, 0-20 degrees) to 63 degrees (range, 15-90 de grees) at final follow-up, and all patients were satisfied with the re sult. The mean follow-up interval was 4.6 years. The regenerative prop erties of articular cartilage as well as the physis in the skeletally immature may permit a radically different approach from that accepted in adults. Such an approach can spare the native joint and restore acc eptable function.